Foot deformity with displacement of the big toe and protruding bone is one of the most common orthopedic pathologies.At first, the disease appears as a cosmetic defect and does not cause any particular problem, but if not treated, it progresses with age.The legs get tired quickly while walking, pains start, problems with choosing shoes arise, and the defect is increasingly difficult to correct even with surgery.Therefore, start treatmenthallux valgus (foot valgus)necessary as soon as the first signs of the disease appear.
Causes of hallux valgus
It is a multifactorial disease that develops due to hereditary predisposition, other diseases of the musculoskeletal system, neurological pathologies and metabolic disorders, as well as external factors.
Internal reasons:
- hereditary tendency to hallux valgus
- transverse and longitudinal flat sole
- inflammatory processes (mainly arthritis: psoriatic arthropathy, gout, rheumatoid arthritis)
- congenital biomechanical instability of the foot
- hyperelasticity syndrome, connective tissue dysplasia
- neuropathy of various origins
- deformation of the knee and hip joints
External provoking factors:
- injuries associated with sprained ligaments of the foot and ankle, joint injuries and broken bones of the foot
- she wears narrow-toed, anatomically incorrect high-heeled shoes
- occupational risks: prolonged transport of heavy objects, prolonged standing
Hereditary tendency to hallux valgus cannot be considered as the cause of the disease in itself, but rather an increased risk factor, which is almost always triggered by negative external factors.
What happens with hallux valgus
Valgus deformity- it is not only an aesthetic defect, which causes women a lot of inconvenience due to restrictions on the choice of shoes (the disease is much more common in women than in men).Changes occur in the entire musculoskeletal system of the foot, which gradually progress and after a while enter an irreversible stage.What happens to the leg?
- Spreading the leg, changing the anatomical shape, reducing the bending.
- Displacement of the first metatarsal bone and an increase in the angle between it and the second metatarsal bone.
- A deviation of the big toe at an angle relative to the first metatarsal bone, the head of which takes the form of a protruding knot (hence Hallux valgus is often called knots or bunions).
- Subluxation of the metatarsophalangeal joint, leading to rotation of the sesamoid bones.
- Violation of biomechanical indicators: indicators of reduced motor and support functions.
- Changes in bone, cartilage and the entire joint.First, the area of the head of the first metatarsal bone suffers: the tissues become more sensitive, the bones become inflamed and damaged, bursitis may develop, and the cartilages die.The lumen of the joint space narrows, focal cystosis develops with local osteoporosis.
Hallux valgus symptoms
The disease does not develop in a week or a month;from the beginning of clearly visible pathology (in stage I, the toe deviates from its normal position by 20-30°) to the third degree of hallux valgus (the big toe deviates by more than 40° and is usually placed on the second) it can take more than a decade.
External manifestations of the disease:
- Deviation of the big toe to the side (outwards from the inner surface of the foot) and protrusion of the bone.
- Hammer-shaped foot (the 2nd and 3rd toes are deformed and become hammer-like, i.e. they bend at the joints).
- Tiredness of the legs, pain that often worsens in the evening and at night.
Diagnostics
The diagnosis is made on the basis of the data obtained during the external examination and X-ray of the foot.In order to find out the causes of the disease, the orthopedist collects an anamnesis (during the conversation, he asks the patient about his occupation, hereditary diseases, previous injuries, lifestyle, habits), makes a referral for laboratory tests and other specialist consultations.The fact is that hallux valgus can be caused by autoimmune and systemic diseases (such as rheumatoid arthritis), metabolic disorders, and neurological disorders.After an examination, during which concurrent diseases are often diagnosed, treatment is prescribed.
Hallux valgus treatment methods
In the initial stage of the disease (grade 1 hallux valgus), conservative treatment is prescribed: gymnastics, wearing unique orthopedic insoles to prevent flat feet, massage, foot baths and medications.It is also recommended to wear elastic braces (protectors of the head of the first metatarsal bone) called valgus splints.In case of inflammation, physiotherapy treatment is prescribed: magnetotherapy, electrophoresis, paraffin therapy, etc., painkillers.
The orthopedist, if necessary, gives recommendations for changing lifestyle and nutrition.For example, many patients have to switch to a diet diet in order to get rid of excess weight and not provoke disease.It is also advisable to limit excessive physical activity, often walk barefoot on the ground and on small stones, use the orthopedic mat, buy safe shoes that do not squeeze the toe, because of which the foot does not bend and the center of gravity of the whole body does not move.
However, all conservative methods can only slow down the course of the disease, but cannot get rid of it forever.Therefore, surgical treatment is prescribed in difficult cases.More than 100 different patented methods have been developed to treat hallux valgus.All are based on distal angulation and proximal osteotomy with reconstruction of the foot to correct the deformity.To perform the surgery, the first metatarsophalangeal joint is released through an incision in the skin.The surgeon then cuts the bone and places it in the functionally correct position.With the help of osteotomy, it is possible not only to correct the deformity resulting from the deviation of the finger, but also to lengthen or shorten the bone if there is a concomitant pathology.As a result, it is possible to achieve a long period of compensation or completely eliminate the pathology, maintain or restore the functions of the joint.
Basic methods of surgical correction of hallux valgus:
- Corrective osteotomy of the first metatarsal bone (chevron, wedge-shaped, SCARF+Akin (with resection and rotation), Lapidus arthrodesis.
- Osteotomy with bioabsorbable implants.
The final choice of the treatment method is only possible after examining and determining the degree of deformation and the individual clinical and radiological picture.
After the corrective osteotomy, the supporting function is restored, the pain ceases, corns and calluses do not form, the soft tissues do not swell, all components of the deformation cease: the finger is placed in its anatomically correct place, the cartilage is not destroyed, the joint is not deformed.The patient can live a full life, play sports, walk, run, and wear comfortable shoes.